otherspoon

Tuesday, June 1, 2010

Unnecessarily Burdensome.

I've been pointing to Thaddeus Pope a lot lately and for good reason; he's keeping us apprised of cases around the world that address futile care, and in a way that is provocative and not monolithic. That's refreshing when so often commentary regarding health care comes as announcements, not invitations to think. Take for instance the last paragraph in this quote from Pope's site of an article in the Yorkshire Post. Pope highlights the interesting bits that work to change the way we look at patient choice as limited only to effective care - that's a huge paradigm change from the rampant demand for treatments until the last days of life, regardless of their efficacy (see Montana Republican state senator Greg Hinkle in my prior post.)

Barbara Evans' daughter was "shocked" to discover that a DNR order had been written on her mother's medical notes. She explained, "I was shocked because this issue had never been discussed with either my mother or the family." (Yorkshire Post, June 1, 2010)

A Leeds Teaching Hospitals NHS Trust spokesman said:

The trust policy states explicitly that in most cases patients should be informed of any clinical decision not to attempt resuscitation. We do discuss cardiopulmonary resuscitation (CPR) decisions with patients and/or their relatives where we feel there is a genuine choice to be made – that is when we think that it could be successful, but even then the patient may not want CPR to be attempted. Our policy emphasises that, where there is a real, and difficult choice to be made, the patient's view is of paramount importance.

The spokesman further explained:

However we may feel that to attempt CPR would be medically futile, and that there is no real decision for the patient or their relatives to make. Even then, we now recommend that most patients should be told, as part of the process of keeping them informed about the seriousness of their condition. For some patients, for example those who know that they are approaching the end of their life, information about interventions that would not be clinically successful would be unnecessarily burdensome and of little or no value. Such patients could be distressed by receiving what could appear to be unnecessary and unhelpful information, in the same way that we would not talk about an operation or other treatment that would not help them.

Denying Death in Montana's Legislature

Here we go: Montana Republican state senator Greg Hinkle has introduced a bill that would make it illegal for a doctor to give a mentally competent, terminally ill patient a lethal prescription. The bill is a reaction to the New Year's Eve decision by the state supreme court that aid in dying is not prevented under the current state constitution. Those of us watching the state since the New Year have been noting the battle brewing there. Compassion and Choices, participants in the Baxter v. Montana case, have been running ads to make more citizens aware of the dying process and the way aid in dying works. They've rightly anticipated moves like this by legislature and "pro-life" groups to temper that ruling. Hinkle's statements in this article are, I think, very telling of the mindset he represents.

Hinkle says a family member was told he only had a short while to live. That was over 30 years ago and he's still alive with great grand kids. He thinks people could take advantage of a sad person for malicious purposes. He says "If you're in a depressed state, which some people can be, then they might say I give up instead of fighting it. Look at how many cases of people with debilitating diseases who are going to fight .

The common argument against aid in dying takes these points as evident, moral and worthy of state enforcement:

1. Doctors misdiagnose and miracles do happen (meaning God can reward us with a reprieve from a terminal illness)

2. Society, termed the "culture of death" by "pro-life" groups, is out to kill. Hinkle and others see themselves as protectors of moral and religious behavior.

3. A patient who "gives up" on life by asking for aid in dying doesn't deserve to have their suffering alleviated. In other words, those who accept that death must come are not victims of a terminal disease but victims of their own lax morals. And yet, those who request aid in dying have most often fought their disease for years - in Baxter's case it was 12 years - with a strong will to live.

4. By legislating that all patients refuse to "give up," Hinkle is arguing for futile care, that each of us deny the likelihood of death and accept the physically, emotionally and financially costly treatments that can't save life but can only prolong death, if not for themselves then for a society that works to deny death.

About Me

I'm a writer (and hospice volunteer) living in Red Hook, Brooklyn, and writing primarily about the nexus of death and religion for publications like Guernica magazine (where I'm a contributing nonfiction editor), Lapham's Quarterly, Bookforum, The Nation, and Killing the Buddha.

I am a Visiting Scholar at The Center for Religion and Media, NYU, and a contributing editor at The Revealer, the Center's publication (where I was editor until June 2013). I write the monthly column, "The Patient Body."

The Good Death: An Exploration of Dying in America will be published by Beacon Press in January 2016.

You can find my articles at annneumann.com.
I can be reached at otherspoon@yahoo.com, @otherspoon